Public Health: An Instrument of Social Justice

In 1996, Dr. Pavani Ram, associate professor of epidemiology and environmental health, observed the care for two patients who have impacted her life to this day. In Tamil Nadu in South India, a woman at 43 weeks pregnant – 3 weeks post due date – delivered a stillbirth, likely due to a lack of sufficient antenatal care. Another patient, a woman dying of congestive heart failure, was suffering alone in a small hut in a remote, rural community. These encounters caused Dr. Ram to reflect: what are the barriers to care for populations living in communities where health services are not available and what does it take to deliver high quality care in these types of low resource settings? These questions have formed the basis of her life’s work – using public health’s power as an instrument of social justice for women and children.

In medical school, Dr. Ram worked in the Office of Child Health in the NYS Department of Health and Mental Hygiene. She quickly realized the power of public service to improve access to health care for large segments of the population. After receiving her MD from Mount Sinai School of Medicine (now the Icahn School of Medicine at Mount Sinai) and training in internal medicine at Washington University School of Medicine, Dr. Ram served with the Epidemic Intelligence Service (EIS) at the Centers for Disease Control. Dr. Ram notes EIS as the best two years of her career. She learned everything from data entry to analysis, and to public health in action. While an EIS officer, in 2002, she traveled to Afghanistan to investigate water quality issues and opportunities to introduce household water treatment; to Bangladesh to investigate risk factors for infectious diseases like typhoid fever; and to eastern Madagascar to understand the deep challenge of providing public services like water, sanitation, and health care in remote, rural communities.

For Dr. Ram, public health is an instrument of social justice because health is a human right. Member nations of the United Nations work tirelessly to uphold this standard through the Universal Declaration of Human Rights. Yet, inequity persists. It is everywhere – affecting low-income families in Bangladesh, Afghanistan, and Madagascar as well as here in the United States.

However, high-income countries benefit from global economic inequities that ensure we live in a level of comfort that is deeply enjoyable. We rely on a global market that works in our favor but comes at a huge cost to the livelihoods and health of people suffering global economic and environmental changes. An example: Rwanda is experiencing a resurgence in malaria. Although eliminated in the United States in 1949, malaria persists in many low- and middle-income countries, killing over 1,000 children every day. Changing global temperatures, an effect of carbon pollution, have resulted in a thriving mosquito vector and wards full of young children with malaria. “Kids are dying because of my choice to drive my gas-guzzling mini-van,” notes Dr. Ram.

Dr. Ram studies behavior change and social norms. The collective actions and behaviors of people around the globe – driving a car or bicycling, using plastic bags or bringing a bag from home, washing one’s hands after using the restroom or not – have a significant impact on the health of populations and our planet. Dr. Ram could reduce emissions from her car by decreasing the amount of time she drives; however, her individual action cannot lead to the change needed to improve health and wellbeing for populations, or the ward full of young Rwandan children suffering from a disease that can be eliminated. Public health, the population level medicine, as well as policies and multi-disciplinary partnerships intended to effect change at scale is required.

Dr. Ram joined UB in 2005 and has had the tremendous opportunity to be a member of the faculty in the Department of Epidemiology and Environmental Health in the School of Public Health and Health Professions. She has learned from her colleagues how real science can inform policy change. Her work, in collaboration with colleagues in the Schools of Architecture and Planning and Engineering and Applied Sciences led to the establishment of the Community of Excellence in Global Health Equity (CGHE) at UB. CGHE exists to support global health leaders, organizations, and policy makers who can affect systemic change as well as community members around the world who inspire, promote and implement solutions in their neighborhoods. UB Faculty and students from across the University are teaming together to tackle big challenges in global health including antimicrobial resistance, food equity, refugee health and wellbeing, and child health.

More recently, Dr. Ram joined the USAID Office of Maternal and Child Health and Nutrition as Senior Medical Advisor for Newborn Health. The lead global health and development agency for the United States, USAID funds maternal and child health programs in 24 priority countries with the highest child and maternal mortality rates. She supports strengthening USAID funded programs by informing program evaluation, infection prevention and control, and social and behavior change activities related to prevention of newborn mortality.

Since 2015, Dr. Ram has served as the Co-Director for the Community for Global Health Equity. Though she will be rotating out of this role in August 2018, she will remain a vital member of this Community. UB has greatly benefitted from Dr. Ram’s passion for promoting health equity – but it is her human decency that has, to a significant degree, shaped CGHE. Having set the Community into motion – encouraging faculty to work globally, sometimes out of their comfort zones; connecting UB faculty with influential leaders around the world; and launching innovative educational programs – Dr. Ram will now focus on her research. Thank you, Dr. Ram, for your grit, focus, and good heart.